The tide is turning on child mortality. For the first time, infectious diseases like measles, malaria and diarrhoea are no longer the leading killers of young children around the world. That position is now taken by complications resulting from premature birth, a problem for both wealthy and low-income countries.

While deaths from infectious diseases have been steadily declining as a result of research and medical intervention, preterm birth has remained a much more difficult problem, say the authors of a recent study that collated child mortality rates and their associated causes between 2000 and 2013. For the purposes of their research, preterm birth was defined as any child born at less than 32 weeks.

Of the 6.3 million children around the world who died before the age of 5 last year, 1.1 million died from complications associated with being born early. This was more than those who lost their lives to any single infectious disease. The next biggest killers were pneumonia, complications during delivery such as a lack of oxygen and congenital abnormalities. Taken together, the number of deaths from all infections is still higher than the combined number of neonatal problems, but only by 6 per cent. “This really marks a tipping point,” says , a perinatal epidemiologist at the London School of Hygiene and Tropical Medicine, who was part of the team that collated the data. “It shows where people have invested.”

The countries where the highest numbers of children die this way each year were India, Nigeria, Pakistan, Democratic Republic of the Congo, and China.

Back to basics

Preterm birth complications are a problem worldwide but the causes are different, as are the ways the problem will likely be tackled.

“One of the main messages here is that, particularly in low-income countries, preterm babies are dying of very simple things: being too cold, not being able to suck or not feeding properly,” says Lawn. “These are things that don’t necessarily involve machines and intensive care.”

So the emphasis in poorer countries needs to be on improving basic treatments that can have a big impact. Simple measures like improved feeding, infection prevention and antibiotics could go a long way to reducing these neonatal deaths, says Lawn.

In more developed nations, doctors are trying to prevent babies being born early in the first place. Contributing factors include women giving birth later in life, high blood pressure, obesity, smoking and the increased rates of elective caesarean sections which can result in preterm birth if there is ambiguity about the date of conception. But Lawn estimates that these factors only account for half the picture in developed countries, and even less in low-income countries.

Mysterious phenomenon

“Probably the biggest research gap is actually for the places where preterm birth is highest, which is southern Africa, but where the risks are different – there we have almost no C-section, no smoking, no big problems with diabetes and obesity,” she says. “There are actually things that we might be able to do more about, but there’s very little research into them.”

And that’s the problem. We know very little about what triggers full term labour, let alone preterm. Since last year, over $250 million in funding has been announced to investigate the causes of preterm birth. But Lawn points out that all of the initiatives are US-based, and over half the funding is coming from the Bill & Melinda Gates Foundation alone. If the research is going to have any real global impact, it will have to look beyond the causes and measures required in wealthy nations like the US, she says.

“There are some aspects of childhood death that are quite easy to reduce if you have the interventions: things like pneumonia, malaria, and diarrhoea,” says Cesar Victora, an epidemiologist at the Federal University of Pelotas in Rio Grande do Sul, Brazil. “But preterm birth is very complex – it’s not one disease. That makes it harder to prevent. I think a lot of people have not realised how big this problem really is until now.”

Journal reference: The Lancet, DOI:

Biomedical engineers design and maintain vital hospital equipment (Image: Chassenet/BSIP/Corbis)

Biomedical engineers are essential to the high-tech world of health, but a dearth of them is costing lives

PATRICK FINLAY found his calling at an unexpected moment – during the birth of his son 29 years ago, when doctors said that the baby needed to be delivered using forceps. “They produced these stainless steel torture instruments that looked like something out of a medieval castle,” he says. “I thought, we must be able to do something better than this.”

Finlay, then a robotics engineer, decided to start designing robots for use in surgery, joining the field of biomedical engineering. Now, three decades later, hospitals are technologically transformed. From imaging equipment like MRIs and CT scanners, pacemakers, prosthetics, and computer simulations for surgery, big hospitals in the UK now play host to at least 20,000 pieces of equipment that require the oversight of biomedical engineers to procure, develop and maintain.

That is why the UK is in desperate need of biomedical engineers, says Finlay, chairman of the Institution of Mechanical Engineers’ . In fact, a lack of biomedical engineers working in the National Health Service (NHS) is putting lives at risk, he says.

According to the Medicines and Healthcare Products Regulatory Agency, . Defective or unavailable equipment are also common reasons for cancelling surgical operations.

“Technology and medicine now go together, and so it’s becoming increasingly important to have an engineering specialism within the hospital and within wider healthcare,” says Finlay, who detailed his opinions in a report published in July.

Biomedical engineering encompasses electrical engineering, software engineering, mechanical engineering, medical physics and materials technology. “It’s a broad and messy group of people from a whole range of backgrounds,” says Peter Jarritt, a co-author of the report, who recently retired after heading the department on medical physics and clinical engineering at Addenbrooke’s Hospital in Cambridge for six years.

The demand for biomedical engineers goes beyond the NHS. Sales in medical technology products come in at around £325 billion globally. The sector is growing faster than any other in the life sciences, and sales are set to outpace even the pharmaceutical industry.

To help meet the demand, universities are having to design training programmes that bring together the various scientific fields that together make up biomedical engineering.

Embarrassment of riches

Sheila MacNeil, a tissue engineer at the University of Sheffield, directed the launch of the university’s bioengineering degree. Now in its fourth year, the course’s initial problem was “an embarrassment of riches”, says MacNeil. Nearly 80 existing modules came under the banner of bioengineering, but the crucial core components include human physiology and biology, engineering principles, and maths.

The broad nature of biomedical engineering training can work to students’ advantage, says MacNeil. “In a traditional school environment, you get asked to make choices: do you want to do chemistry or maths; do you want to do physics or biology?” she says. In an interdisciplinary programme, students see how all those pieces interact when they are united by the idea of applying engineering principles to improve patient health outcomes.

Once you’ve got that broad engineering degree under your belt, it’s time to choose a career path. The NHS offers a paid, three-year , which provides graduates with workplace training alongside an accredited master’s degree, and is a route to a role within the health service. Trainees can specialise in areas such as rehabilitation engineering, clinical measurement and development, medical device risk management and governance, prosthetics and imaging. Clinical engineers, for example, tend to focus on the design of diagnostic and treatment equipment, while rehab engineers might spend their time adapting and fitting wheelchairs and prostheses for the people that need them.

Within the private sector, roles in designing, developing and manufacturing medical devices are available. With four years of experience under your belt, you can apply for chartered engineer status – which can boost your employability.

Finlay, who now runs his own surgical robotics business, says he struggles to find graduates trained in both engineering and human physiology. “I would love to employ biomedical engineers if there were enough of them,” he says.

“I would love to employ biomedical engineers if there were enough of them”

Rob Meijer is a mechanical engineer who was drawn to a career in health. After graduating, he applied his understanding of physics and maths to a wide range of jobs, from theatre set design to the restoration of a Victorian telescope. Eventually, Meijer chose to work in the development of artificial limbs.

“What drew me to prosthetics is that it’s still gears and motors, but the very important thing is you’re doing something that makes a real difference to people,” says Meijer, now a design manager at prosthetics firm in Livingston. The most challenging aspect of the work, he says, is being patient, because taking an idea from the research stage through to production can take years.

MacNeil, who has been in a decade-long partnership with an NHS clinician developing engineered tissues for urethra transplants, faces similar frustrations. She emphasises that the interface between the NHS and academia needs to be bolstered if the health service is going to benefit from the world-class research going on at the UK’s leading institutions, now ranked second in the world for biomedical engineering.

Finlay, however, is optimistic about the situation. He says the UK is well-positioned to take the lead on biomedical engineering because it has strengths in university research, private industry and the NHS. “Put those together, and if we can sort out the gap in the middle – which is the development, the career path, and the organisation of the profession – we have a well-integrated path for developing and exploiting medical technology for the benefit of patients,” he says. “In fact, probably better than anyone else.”

This article appeared in print under the headline “Medicine’s engine room”

Cyborg cockroaches may be the search-and-rescue teams of the future. The enhanced roaches can pinpoint the source of a noise using electric pulses delivered to their antennae, and then crawl towards it.

The cyborg roaches are the work of Alper Bozkurt and his team at North Carolina State University in Raleigh. They have built two types of audio-sensing “backpacks” that can be strapped on to Madagascar hissing cockroaches. One has a single high-resolution microphone that can identify sound sources fairly accurately. The other has a three-microphone array that gets a precise fix on the source using the amplitude information from each microphone.

Using a computer to integrate the data from a network of 10 to 15 insects, the cockroaches are then guided towards the sound source via automated electric pulses to their antennae. The nerve stimulation causes the insects to turn left or right, essentially by simulating contact with obstacles in front of them. Bozkurt presented the work at a conference in Spain last week. Watch a .

Roaches to the rescue

Hacking cockroaches like this is nothing new. Bozkurt and his group have been working with them for the past five years, and last year a Kickstarter project for the very first time. But Bozkurt’s newest project moves the field into more practical applications. His team hopes the cyborg cockroaches may be used to find disaster victims, for example people buried under rubble in the aftermath of an earthquake.

“Cockroaches as a platform are certainly better in terms of performance than anything we are currently able to build, and that will remain true for many years,” says Shai Revzen at the University of Michigan in Ann Arbor. “But one of the problems with these approaches is that they work well in the lab, where there are no distractions, but are much more tricky to apply reliably in real-world environments.”

That’s why the next stage of Bozkurt’s research is to take the insects out of the lab – though not to a terrain as complex as a dense pile of rubble, as yet. Once the lab phase is complete, his team plans to use cyborg roaches equipped with geiger counters to search for leaks in nuclear power plants.

“There are a number of applications where we can get insect-bot sensors out into the field to collect useful information,” says Bozkurt. “But in the next five or six years, we think this project will be ready to be fully deployed under the rubble.”

There is already evidence that skipping breakfast raises the risk of obesity and in adults. of St George’s, University of London and her colleagues have found the same may apply to children.

The researchers studied 4000 children aged 9 and 10 years old in the UK. They gathered information on how often the kids had breakfast, measured each child’s body fat and collected blood samples. Half of the children then took part in one-on-one interviews with the researchers, in which they attempted to remember everything they had eaten the day before.

The kids who reported regularly skipping breakfast had 26 per cent higher levels of insulin in their blood after a period of fasting than those who reported eating breakfast every day. They also had 26 per cent higher levels of insulin resistance.

Among the children who managed to reconstruct their full menus from the day before, kids who ate high fibre cereal breakfasts had lower insulin levels and insulin resistance than the children who had any other breakfast types.

After controlling for factors including socioeconomic status and levels of physical activity, the results were still significant.

Don’t blame breakfast

“It’s a huge global public health issue, and one that’s certainly relevant in the UK,” says Donin. “There’s certainly an increased awareness that perhaps something needs to be done.”

The study can’t pin the blame on breakfast, though, says at Baylor College of Medicine in Houston, Texas, as overweight individuals have been shown to under-report what they’ve actually eaten.

Donin agrees, and says that conclusive results will need to come from randomised controlled trials. She says that the new study makes the case for such studies stronger.

“When we’ve talked about kids and breakfast before, it has tended to be more about cognitive outcomes and classroom behaviour,” she says. “But now we’re moving more towards something that could also potentially have effects on the long-term future health of kids. We need to look into that further.”

Journal reference: PLoS Medicine, DOI: 10.1371/journal.pmed.1001703

The UK’s coalition government has been strongly criticised by members of parliament over its handling of the decline in pollinating insects. The government has been accused of not doing enough to safeguard the insects, which many crops rely on.

A released today by Parliament’s critiques the government’s draft , which sets out plans to halt the decline in pollinating insects like bees.

Much of the committee’s venom is directed at the government’s stance on neonicotinoid pesticides. Neonicotinoids are thought to be one of the factors contributing to declines in populations of pollinators. Last year the European Union imposed a two-year ban on using the pesticides on bee-attracting crops, but the UK government initially voted against it. The ban is up for review next year. The committee is demanding that the government supports the ban, and doesn’t try to wriggle out of it during the review.

Some plant scientists say the ban on neonicotinoids could backfire. “You can choose to ban or restrict them further on a ‘precautionary principle’,” says of Rothamsted Research in Harpenden, UK. But she says such a precautionary approach has problems of its own. “It seems to not take account of the risks of actually implementing the ban.” She points out that crop production could fall, and that farmers might resort to other pesticides that are more toxic.

Follow the money

The committee’s other major criticism focuses on research funding. Because of a shortage of money, the government is turning to pesticide manufacturers to fund the neonicotinoid research that underpins the National Pollinator Strategy.

That means the research will not be transparent enough, says the committee’s chair . Research by pesticide companies is often not peer-reviewed, or even published in full. “If the research is to command public confidence, independent controls need to be maintained at every step,” says Walley, Labour MP for Stoke-on-Trent North.

, the chief scientific adviser at the Department for Environment, Food & Rural Affairs (DEFRA), defended the decision to turn to manufacturers. Boyd says pesticide companies Bayer and Syngenta were providing funding that “would otherwise need to come from a public source, and at the moment that public source is not available”.

“This government is determined to do all that it can to help bees and pollinators flourish,” says DEFRA spokeswoman Hope Hadfield.

The common cold, hepatitis C… crAssphage? A new virus has been discovered that could lurk in the guts of almost three-quarters of people around the world, making it one of the most ubiquitous viruses you never knew you had.

The virus, which replicates by infecting a species of common gut bacteria, is six times more abundant than all other known gut viruses combined. Its discovery supports the idea that viruses may be the puppet masters of our intestines, regulating the teeming bacterial communities that call our gut home.

“The idea is that viruses can control the levels of bacteria in the gut, to make sure that no one type gets the upper hand,” says of Radboud University Medical Centre in Nijmegen, the Netherlands. “Viruses could maintain the biodiversity within us.”

The fact that the virus is found in so many different people, regardless of where they live or what they eat, overturns the previously held belief that each person’s viral signature is unique, says Dutilh.

The idea that our viral cargoes – known collectively as the virome – vary from person to person came from a that examined the similarities between the gut bacteria of twins. Using genomic data from faecal samples – a good proxy for inferring what’s going on further up in the gut – from four sets of twins and their mothers, the study found that the resident gut bacteria among closely related individuals was far more similar than that between unrelated individuals. Viral communities, on the other hand, seemed to vary widely – even between the twins.

Biological dark matter

But there was a big caveat: only 19 per cent of the virome from the group matched anything from our databases of known viruses. The rest, says Dutilh, is a black box, both because of the vast numbers of unknown viruses out there and because of the rapid evolution of the viruses we do know. This is what he refers to as the realm of “biological dark matter”. “The rest was ignored because we had no idea what they are or what they do,” he says.

Dutilh and his collaborators at San Diego State University decided to dive back into the data to look at whether the study participants shared any of the viral dark matter. One virus – a type that colonises bacteria, called a bacteriophage – was present in samples from all 12 individuals.

When the researchers expanded their search to include all the data from the Human Microbiome Project, a large-scale project to sequence the DNA of all the microbes that live in and on our bodies, they found that the same virus was present in 73 per cent of all 466 human faecal samples. They gave their find the catchy name crAssphage after the DNA assembly software they used to discover it.

“We find it in samples from Europe, Asia and the US,” says Dutilh. “One explanation is that it’s been with us for many generations, spread with humankind over the world. But it’s also possible that it’s in some food that’s eaten everywhere.”

Puppet master

The team were able to show that crAssphage’s most likely host is the bacterium Bacteroides, one of the most commonly found bacteria in our intestines. Bacteroides has been implicated in conditions such as obesity, diabetes and even colorectal cancer, suggesting that the virus may well have an impact on those conditions as well. But since viruses like crAssphage can exist within bacteria in many ways, it’s not yet clear what role it plays.

Whatever it is, says Dutilh, it highlights the importance of the virome as a mechanism of control one level higher than bacterial communities. Further down the line, he says, this could be harnessed for personal , where specially designed bacteriophages can be inserted into the gut to kill or boost certain bacterial populations that have gone awry.

“It has been a very short time since recent technological developments have allowed us to begin uncovering the huge diversity that the viral world contains,” says at Washington University in St Louis, Missouri, who was involved in the virome study on the twins. “Now the goal is to understand the role of those viruses in their microbial community, which, based on their abundance and diversity, must be an important one.”

“The fact that the virome has been overlooked for 10 years is the elephant in the room in microbiome research,” says Dutilh. “Most people just focus on bacteria, but there are also viruses and even fungi. It’s the interaction between all of these things and the host gut that is really important.”

Journal reference: Nature Communications, DOI:

What exactly happened here?
On Wednesday afternoon in Arizona state prison, death row prisoner Joseph Wood was administered a lethal injection. He survived for 1 hour and 58 minutes before dying. Onlookers described Wood as struggling for air for an hour, and one journalist on the scene reported him as .

What were the drugs used?
Wood’s injection consisted of a two-drug cocktail of midazolam, a sedative and anaesthetic, and hydromorphone, a painkiller.

There have been several cases in the last year using midazolam, a non-standard lethal injection drug, and all have been botched. It is approved for use in Ohio, Florida, Oklahoma and Arizona, but, says anaesthesiologist of Harvard University, “They’re working with doses that are clinically absurd – we have no idea what they do.”

Has midazolam caused problems before?
On the four occasions on which it has been used, midazolam has consistently been linked to drawn-out deaths characterised by suffocation. According to Waisel, these reactions are to be expected from the particular drug combination used.

Midazolam was first used as a death penalty drug in the 2013 execution of Florida prisoner William Happ, in a three-drug cocktail. While the Florida state department reported the execution as proceeding without problems, that he “remained conscious longer and made more body movements after losing consciousness than other people executed recently by lethal injection under the old formula”.

The two-drug cocktail saw its first use in the case of . The injection caused McGuire to lurch, gasp, snort and choke until he finally died 25 minutes later.

Arizona decided to go ahead with Wood’s execution using the same cocktail. to Wood’s lawyers and the public.

Why are ineffective drugs being used?
States with the death penalty are running out of options. Over the past few years, international drug manufacturers in the European Union and elsewhere have clamped down on selling drugs to the US for use in executions. The three-drug cocktail typically used for lethal injection in the US – composed of a sedative, a paralytic agent and a third drug to stop the heart – are no longer easy to get hold of. So some states have been turning to so-called , which make non-FDA regulated custom medications for patients with allergic reactions, or novel drug cocktails such as the midazolam-hydromorphone mix.

With combinations that are being tested for the first time in the execution chamber, it’s unclear what will work. “I do not know why they chose midazolam,” says Waisel.

According to , law professor at Fordham University, New York, what is clear is that states should stop choosing it. “The worst thing about the execution last night was that it was such a part of a bigger pattern,” she says. “It’s been known, people have been so warned, and we have this track record now. There’s such a track record you wonder why they’re continuing to take place.”

(Image: Alessandro Bianchi / Reuters)

The shipwrecked Costa Concordia is riding the seas one last time.

The Italian cruise ship disastrously collided with a reef off the coast of the Italian port of Giglio in January 2012. A total of 32 passengers were killed when it capsized.

Now, over two years after the most expensive salvage operation of all time began, the ship is on the move.

On Wednesday morning, tugboats began towing the Concordia at near walking pace on a 300-kilometre journey to Genoa, where it will be chopped up for scrap metal.

The Concordia will also be accompanied by ships monitoring for any toxic substances leaking from the wreck.

Now that the ship has left Giglio, the authorities will reinstate their search for the body of Russel Rebello, one of the ship’s waiters whose remains were never found.

Watch the journey of the Concordia live on this .

(Image: Courtesy of the owner)

In the market for a really fast ride? If so, 8 September may be your lucky day. Collectors looking to shell out for a major piece of aerospace history will have a chance to place their bids on this CIAM-NASA HFL “Kholod” scramjet, one of the fastest machines ever to fly.

The first Kholod was , just weeks before the dissolution of the USSR. CIAM then joined forces with NASA and in 1998, the rocket flew at a record-breaking Mach 6.47 – nearly 8000 kilometres per hour.

(Image: Courtesy of the owner)

Nine Kholod rockets were made, but five were destroyed during test flights, so you’re unlikely to feel the embarrassment of rolling up next to another one at a red light. As for how much this little beauty will cost you, we don’t know – it’s being .

Not a good plan

The big picture